Lymphogranuloma venereum: Difference between revisions
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Revision as of 13:53, 30 July 2020
Background
- Infection caused by Chlamydia trachomatis serovars L!, L2 and L3
- Transmitted sexually through vaginal, anal, or oral contact
Epidemiology
- Uncommon in Canada but more common in parts of Africa, Asia, South America, and the Caribbean
- Occasional outbreaks among men who have sex with men
Clinical Manifestations
Primary LGV
- Incubation period 3 to 30 days
- Starts with small painless papule at site of inoculation that may ulcerate
- Only noticed in 50% of patients
Secondary LGV
- Latency of 2 to 6 weeks from primary lesion
- Presents with systemic symptoms, including fevers and chills, malaise, myalgias, and arthralgias
- May have abscess with or without draining sinuses
- Occasionally involves arthritis, pneumonitis, hepatitis, and rarely involves carditis, aseptic meningitis, or ocular inflammation
Secondary LGV with lymphadenopathy
- Most commonly involves painful inguinal or femoral lymphadenopathy, called "buboes"
- The "groove sign", where nodes are seen above and below the inguinal ligament, is highly specific for LGV
Secondary LGV with anorectal symptoms
- Presents with acute hemorrhagic proctitis
- May also cause constipation
Tertiary LGV
- Also called chronic LGV, and occurs in 10 to 20% of untreated patients
- Characterized by chronic inflammation that causes:
- Lymphadtic obstruction leading to genital elephantiasis
- Genital and rectal strictures and fistulae
- Can cause esthiomene, extensive destruction of genitalia
Investigations
- Anoscopy/sigmoidoscopy/proctoscopy
- Similar appearance to ulcerative colitis
- Bubo aspiration
- Usually contains small amount of milky fluid
- Aspirate through healthy skin
Prevention
- Consistent use of condoms or other barrier methods, including for oral sex
- Avoid mucosal trauma if possible